Coded as K98.1 in ICD 10, antibiotic-associated diarrhea (AAD) is a stool disorder that is not associated with infection or other causes. This condition is preceded by the use of antibacterial drugs. Diarrhea is said to occur if loose stools are observed three times two days in a row or more often. Sometimes ABP is fixed some time after the completion of the therapeutic course - up to eight weeks.
General view
Encrypted by the symbols K98.1 in the ICD, antibiotic-associated diarrhea in rare cases can develop against the background of infection, but is more often explained by the direct effect of drugs on intestinal motility or indirect influence. In addition, the drugs have a strong effect on different parts of the digestive system, which can also cause unformed pathological stools. A good example is macrolides, which have a motilin-like effect. The course of treatment with drugs with ceftriaxone cancause sludge syndrome. Manifestations of a pathological condition in this form of the disorder disappear on their own some time after stopping the drug. A specific program for correcting the patient's condition is not required.
K98.1 - ICD 10 code for antibiotic-associated diarrhea, that is, stool disorders due to a therapeutic course of antimicrobial drugs. As can be seen from clinical data and medical statistics, almost 37% of patients who are forced to take medications in this group experience manifestations of AAD, which is recorded in their personal medical history. The indicated frequency is a minimum estimate for those suffering from gastrointestinal disorders, but some experts are convinced that the problem is much more common. A not entirely accurate estimate of the number of cases is associated with a tolerant assessment of manifestations - both patients and doctors do not perceive the phenomenon as a pathology. This is especially characteristic if the violation of the stool is observed in mild or moderate severity.
Shapes and nuances
The ICD code for antibiotic-associated diarrhea K98.1 includes several clinical forms of the pathological condition. Recently, a classification system that involves the evaluation of manifestations has been widely used. There is AAD without signs of colitis, AA colitis and pseudomembranous. When infected with certain forms of Clostridium, AAD is classified as having no signs of colitis, and there are also three varieties of it: fulminant, pseudomembranous, and a form without pseudomembranes.
Up to 20% of all cases are due to Clostridiumdifficile species. The code K98.1 used in the ICD for antibiotic-associated diarrhea also includes other cases, which account for (cumulatively) about 80% of all patients. These are situations in which a violation of the stool is associated with other forms of clostridia, fungal microflora, cocci, salmonella, klebsiella. The latter, as established, most often cause a segmental hemorrhagic pathological condition of the gastrointestinal tract.
Diagnosis and classification
In 2009, infectious disease specialists, microbiologists, members of the European Union of Physicians, published clinical recommendations that are relevant for antibiotic-associated diarrhea. An impressive volume of scientific work was devoted primarily to the most common forms of microflora - Clostridium difficile. Problems of diagnostics and therapy of such cases were considered. The specialists paid special attention to the assessment of the severity of the patient's condition, the formulation of the prognosis. A year later, American epidemiologists issued practical recommendations for the monitoring, treatment of patients with AAD, in which this form of microflora dominates.
The urgency of the problem of diarrhea after antibiotics in adults and children is associated with insufficient knowledge of the issue. In particular, for the type of pathological life form mentioned above, a new strain has only recently been identified, which is characterized by a significantly more active production of toxic components in comparison with those known before. The difference reaches 23 times. Infection with this strain causessevere AAD. Among the substances generated by the microflora is a binary toxin. The measures taken so far have not allowed to clarify what effect this substance has on a person. A specific feature of the identified type is increased resistance to fluoroquinolones. From this, the doctors concluded that the use of fluoroquinolones may be one of the provoking factors for AAD.
Nuances and manifestations
Antibiotic-associated dysbacteriosis, AAD can develop in different forms. Some patients have mild diarrhea that resolves quickly. Others are diagnosed with severe colitis, associated with the danger of death. In the predominant percentage of cases, the manifestation is expressed by a weakening of the secretions, weak manifestations of colitis. There are no general symptoms. The chair happens up to four times a day, accompanied by moderate soreness, resembling contractions, in the abdomen. The temperature remains normal. On palpation, hypersensitivity can be determined, but not always. Gas formation is also more active than normal, but the difference from a he althy state is not very big.
Antibiotic-associated diarrhea in children and adults does not manifest itself as markers of inflammation in the circulatory system. Symptoms are usually relieved by taking specific drugs, canceling the course of antimicrobial agents. To quickly improve the condition, it is recommended to use probiotics, anti-diarrhea agents. Doctors have established precisely: this condition is associated with an imbalance in the composition of the intestinal microflora,dysfunction of beneficial bacteria. There is no proliferation of pathological microscopic life forms.
Instances: sometimes harder
The treatment of diarrhea after antibiotics is significantly different if the clinical manifestations of Clostridium difficile-associated AAD in the case of colitis are of concern. Such a condition can be suspected by a strong, unpleasantly smelling discharge, in which mucous inclusions are noticeable. The chair is profuse. Bowel movements are accompanied by tenesmus. The patient is concerned about pain, resembling contractions, in the abdomen. On palpation, this area is soft, some areas respond with increased sensitivity (colon). Listening allows you to determine: noises in the intestines are more than normal.
If diarrhea after taking antibiotics is associated with the specified form of life, the patient has a fever (a state of moderate severity). There is general dehydration of the body, the patient feels sick, vomits. A blood test shows an insignificant leukocytosis even if there are no typical manifestations of diarrhea. Colitis is most often localized in the right side of the colon, indicates itself with foci of pain, an increase in the content of leukocytes in the blood, and a feverish state. Diarrhea is mild or absent.
Variants and cases
Sometimes diarrhea after taking antibiotics is severe. Toxic megacolon is accompanied by rare stools. In clinical practice, cases of inadequate assessment of such progress in the patient's condition are known - sometimes doctors (and patients themselves) take a symptom as a sign of improvement. At the same time, ingas is retained in the intestinal tract, the peritoneal region is irritated, the person is in a fever, studies reveal a distension of the colon. A detailed study of the patient's condition helps to detect effusion in the peritoneum, small pelvis. In the circulatory system, an increased level of leukocytes is established, and the concentration of albumins, on the contrary, is below normal. In addition, hypovolemia is detected. These manifestations are a typical clinical picture.
If antibiotic-associated diarrhea progresses in this form, the patient should be referred for an x-ray. In poisoning megacolon, the colon expands. Research helps to identify intestinal pneumatosis. After a CT scan, it is possible to establish a thickening of the intestinal wall, narrowing of the lumen, compaction of fatty structures surrounding the intestine, as well as ascites. The condition is quite severe, so deterioration to this level of diarrhea after antibiotics should be avoided. What to do if progress has nevertheless reached this stage, qualified doctors know: the patient is shown an urgent operation. However, as can be seen from medical practice, the predominant percentage of patients are faced with quite severe complications, negative consequences of the intervention. Increased death rate.
Problem: typical cases
If earlier antibiotic-associated diarrhea was mainly explained by relatively safe forms of pathological microflora, recently the most dangerous strain of clostridia, BI/NAPI, has become more frequent. More oftenMost outbreaks of this type of AAD are observed in hospitals, where patients are forced to undergo long courses of antimicrobial treatment. Such AADs are much more severe than other types and forms of pathology.
Usually, symptoms begin to appear on the fifth day after the start of the antimicrobial program, sometimes it takes twice as long before the primary manifestations. Isolated cases of AAD symptoms are known already on the second day of taking medications, but there are also late variants, when the first manifestations occurred on the tenth week after the end of the course of antibiotic treatment.
BI/NAPI: Mild AMA
Antibiotic-associated diarrhea of this type is manifested by a decrease in the functionality of the small intestine and contamination of this organ. Abdominal digestion of food weakens, fermentation, decay with the participation of bacteria become more active. The acidity of the contents of the intestinal tract falls, as a result of which the activity of lipase is lost. The patient has steatorrhea, soap compounds and fatty structures are formed in the intestinal tract. Fat-soluble vitamin substances are absorbed much worse, which provokes endogenous polyhypovitaminosis.
Because adsorption and digestive processes in the small intestine are disturbed, antibiotic-associated diarrhea causes active gas formation and imbalance of intestinal motility, resulting in a persistent dyspepsia syndromic complex. Too active production of organic acids due to reactions activated by the microflora leads to an increase in the osmolarity of the obsessed gastrointestinal tract. The consequences of the phenomenon are bloating, flatulence, diarrhea, bursting soreness, which comes in attacks. Dysbiosis provokes a high level of permeability of the intestinal barrier, which initiates an allergic response of the body. Excessive development of microflora in the small intestine can cause a weakening of the functionality of other parts of the gastrointestinal tract, as a result - increased pressure, duodenostasis, IBS, pseudo-obstruction. It is possible to start inflammatory processes due to prolonged contamination, deconjugation. Enteritis or duodenitis is recorded in the patient's card.
Continuing consideration
Antibiotic-associated diarrhea associated with Clostridium difficile does not require treatment if it is mild. It is not necessary to correct the patient's condition if the pain is moderate, and defecation is fixed up to four times a day, while there are no general symptoms, laboratory studies show that there are no significant changes. If this condition develops at home, it is strictly forbidden to use antibacterial drugs to get rid of AAD.
As a rule, diarrhea completely resolves on its own when the patient completes the therapeutic course that caused it. In some cases, a doctor may recommend taking probiotics. Without a medical recommendation, no medication should be used, so as not to provoke a deterioration in the condition.
BI/NAPI: Severe AAD
In some cases, AAD proceeds according to a more negative scenario, colitis develops. There are two mainforms: with pseudomembranes and without them. Without pseudomembranes, the process is usually systemic. AAD manifests itself as a feverish state, general poisoning of the body, and abdominal pain. The patient is nauseated and vomits. Stool frequent, watery. Emptying up to twenty times per day is possible. There is dehydration.
Pseudomembranous colitis initially shows similar symptoms. Colonoscopy reveals pseudomembranes. During coproscopy, erythrocytes and leukocytes can be detected. The test for occult blood in the predominant percentage of cases gives a positive result. Sometimes there is hematochezia.
The most severe variant of the pathological condition is fulminant colitis. Occurs in approximately 3% of patients. The condition can cause intestinal obstruction, megacolon against the background of poisoning, intestinal perforation, inflammation in the abdominal cavity, blood poisoning. Fulminant colitis can be suspected if the patient suffers from bright, well-defined pain in the stomach and bloating. Colitis is accompanied by dehydration, fever, hypotension, depression of consciousness or agitation. Toxin A, generated by pathological microflora, directly poisons the central nervous system, which can cause severe encephalopathy.
Case development: attention to nuances
In AAD, there may be manifestations that make it possible to suspect irritation of the tissues of the peritoneum. Perhaps muscle tension in certain areas. Such phenomena are the basis for suggesting intestinal perforation. In laboratory studies, it is possible to establish an increasedthe concentration of leukocytes in the blood, azotemia.
Gastrointestinal obstruction, toxic megacolon, to which the condition can progress, results in less frequent stools. Sometimes colitis is manifested by an abdominal syndrome in an acute form, but is not accompanied by diarrhea. This is also possible with megacolon against the background of poisoning of the body.
Not always a pattern
Atypical AAD may develop. With this form of the disease, the patient suffers from colitis, the integrity and he alth of the small intestine is disturbed. There is a loss of protein structures, enteropathy. Monitoring the patient's condition allows you to identify extraintestinal symptoms.
Clarification
For symptoms of AAD, colitis, including suspected cases associated with the newest and most dangerous strains of Clostridium, a medical history should be taken. If a person has used antimicrobials in the past two months, it should be assumed that the likelihood of AAD is significantly higher than the average. In differential diagnosis, it is necessary to determine the nuances of the course of the case. It is important to take samples of feces, blood, urine for examination, and conduct laboratory diagnostics. It is necessary to check the fact of clostridial infection. AAD is indicated by a lack of albumin, azotemia, the content of leukocytes - 15-16 thousand per mm cu.
If colitis is suspected, first of all, it is necessary to take an x-ray, assess the condition of the abdominal organs. The diagnosis is confirmed by the detection of perforation, megacolon, pneumatosis, ileus. CT may show increased thicknessintestinal walls in separate areas, ascites. Somewhat less often, obliteration, intestinal perforation are detected.
The most accurate and fastest method of diagnosis is the analysis of feces for the presence of pathogens. For this, studies are carried out to identify the content of toxin A. Immunological enzymes are used. The accuracy and sensitivity of modern testing systems is estimated at an average of 75-85%. Methods have been developed for simultaneously detecting toxins A, B. This approach is considered more accurate.
Endoscope to clarify the condition
This study is most cautious if there is reason to believe that antibiotic-associated diarrhea that has progressed to colitis needs treatment. With such progress, the procedure is considered dangerous, since it increases the likelihood of intestinal perforation. To a greater extent, this is characteristic of severe cases.
If pseudomembranous colitis has developed, colonoscopy is recognized as the most reliable way to finally confirm the diagnosis. Given the high risks associated with such an event, the examination is carried out only in the case when it is necessary to determine the diagnosis extremely quickly and with the utmost accuracy, as well as in case of ileus. Colonoscopy is necessary to differentiate the condition and exclude other pathological conditions of the intestinal tract that threaten the patient's life.
What to do?
The best doctors know how to treat diarrhea after antibiotics. The predominant percentage of people are faced with a mild form of AAD, therefore, a specifictherapy is not required. Symptoms disappear on their own when the antimicrobial course is completed. Sometimes symptomatic therapy is prescribed to prevent dehydration, correct the balance of electrolytes in the body. If symptoms suggest colitis, antibiotics are prescribed.
In formulating recommendations on how to treat diarrhea after antibiotics in carriers of Clostridium difficile without typical symptoms, American Union doctors concluded that it is not necessary to give the patient drugs to specifically correct the condition. In general, they complete the antibacterial course and do not use means to prevent secretory activity, intestinal motility - they can provoke active reproduction of pathological microflora.
The main treatment is the use of probiotics, that is, live microorganisms that restore the balance of microflora in the intestinal tract. These are various bacteria: lacto-, bifido-, sticks, cocci, fungal cultures. A number of scientists are convinced that probiotics can be used to prevent AAD. This question is currently open, numerous studies are being carried out to confirm the hypothesis or refute it.
